We have witnessed that terrorists can obtain anthrax and other agents. Years
before the current wave of anthrax-tainted letters, the wealthy and
well-organized Japanese cult Aum Shinrikyo secured anthrax, botulinum toxin,
and Q fever. They tried to release deadly clouds over Tokyo as many as a dozen
times, but without success. They turned instead to sarin gas, which they
sprayed in the Tokyo subway, killing roughly a dozen people and injuring
thousands.

It is not easy to acquire, handle, and disperse deadly biologic agents in
quantities that would cause disease epidemics. However, 12 countries considered
potential enemies of the U.S. have biological weapons programs. And there are
individuals worldwide, including in Iraq and the former Soviet Republics, who
have expertise.

Law-enforcement and intelligence agencies of the federal government are working
to control the flow of expertise and equipment necessary for large-scale
bioterrorism acts. In addition, public-health experts have identified the most
likely disease agents, such as anthrax and smallpox, and are working to improve
our nation's disease-detection system to respond quickly.

The NPS is a large reserve of antibiotics, chemical antidotes, and other
medical supplies set aside for emergencies. The Centers for Disease Control and
Prevention reports that it has the capacity to move these stockpiled materials
to affected areas in the U.S. within 12 hours of notification. There are eight
different stockpiles, strategically located around the country. In addition to
the medical supplies already set aside, the federal government has made
agreements with drug manufacturers to make large amounts of additional
emergency medicine available quickly. For more information on the NPS, go to
http://www.bt.cdc.gov/stockpile/index.asp

Doctors and hospitals should continue to report clusters of illness that may
occur to their local public health officials. Doctors and hospital staff should
be aware of the first signs or symptoms of illness that could be related to a
bioterrorism incident and be prepared to report possible cases immediately
through their local public health officials. In the last few years, a number
of efforts, including satellite training, hospital grand rounds, published
articles in physician journals, and access to Web-based training have helped
improve doctors' ability to detect and treat unusual illnesses.

Some of the "preparations" that have been suggested for acts of bioterrorism,
such as purchasing gas masks and stockpiling antibiotics, are at best of
little value, and at worst risky to your health and the public-health system.

On the other hand, it's wise to take some of the same basic precautions you
would take to prepare for a natural disaster, such as an earthquake. Unless you
are evacuated by local law enforcement during a disease outbreak, you should
"shelter in place." You should have on hand a large enough stock of emergency
necessities to keep your family supplied for a three- to four-day period so
that you do not need to leave your home. An important step is to meet with your
family and discuss why you need to prepare.

The American Red Cross provides a checklist to help family disaster
planning, at the following Web site:

You should not buy a gas mask. A gas mask would only protect you if you were
wearing it at the exact moment a bioterrorist attack occurred. Unfortunately, a
release of a biological agent is most likely to be done covertly. You would not
know ahead of time to put on your mask. To wear a mask continuously or "just in
case" a bioterrorist attack occurs is impractical, if not impossible.

Also, to work effectively, gas masks must be specially fitted to the wearer,
and wearers must be trained in their use. Gas masks purchased at an Army
surplus store or off the Internet carry no guarantees that they will work.

More serious is the fact that gas masks can be dangerous. There are reports of
accidental suffocation when people have worn masks incorrectly, as happened to
some Israeli civilians during the Persian Gulf War.

Surgical masks don't carry the risk of suffocation and are inexpensive. They
may offer some protection against biological agents, but like gas masks they
need to be worn at the time of exposure.

It is not necessary to have a personal stockpile of antibiotics, and
panic-buying and the misuse of antibiotics poses serious health threats for
individuals and dangers to the public-health system.

The most likely cases of bioterrorism will affect only tens or hundreds of
people and require only small supplies of readily available drugs. In the case
of a significant bioterrorist attack affecting thousands of people, the
government has an emergency supply of antibiotics and other drugs that can be
sent anywhere in the U.S. within 12 hours. Public health officials are working
to increase these supplies to be ready for even the remote likelihood of a
large-scale bioterrorist attack affecting millions of people.

Reasons not to stockpile antibiotics:

Hoarding may create shortages in areas where drugs are needed to treat
patients with chronic diseases and immediate needs.

Antibiotics have a limited "shelf life" before they lose their
strength.

There are a number of different germs a bioterrorist might use to carry out
an attack. No single pill can protect against all types of attacks.

Critically, antibiotics should only be taken when needed and with medical
supervision. They can have serious side effects and drug interactions. Misuse
of antibiotics leads to the evolution of drug-resistant germs. Such misuse
could render currently effective drugs useless in the future—for you as an
individual and for the public at large.

No. Except for military personnel who may enter a war zone, vaccination is
currently not recommended and the vaccine is not available to healthcare
providers or the public.

The current anthrax vaccine requires six shots over an 18-month period, and an
annual booster is recommended. Only limited supplies of the vaccine are
available even to the military. The CDC is increasing stockpiles of this vaccine
because it might be useful, in conjunction with antibiotics, in treating people
exposed to anthrax. And a new vaccine is being developed under a Defense
Department contract that might eventually be widely available.

No. Vaccination is currently not recommended, and the vaccine is not available
to healthcare providers or the public. In the unlikely chance a case of
smallpox is detected, the Centers for Disease Control and Prevention has an
emergency supply of vaccine to treat 15 million people. Unlike many vaccines,
which take weeks or months to be effective, the vaccine for smallpox is
effective if given 2-3 days after exposure and can prevent a fatal outcome even
when given 4-5 days after exposure.

Supplies of smallpox vaccine are being increased. Public health officials are
considering whether routine vaccination should be re-instated. The threat of
potential biological weapons use must be weighed against the risks of routine
vaccination: The vaccine can cause serious side effects.

Probably not. Vaccination has been shown to wear off in most people after 10
years but may last longer if a person has been vaccinated on multiple
occasions. If health authorities determine that you have been exposed to
smallpox or are at risk of infection, they would recommend that you be
re-vaccinated immediately.

Yes. It would be extremely difficult for a bioterrorist to contaminate our
drinking water supplies to cause widespread illness.

Huge amounts of water are pumped daily from our reservoirs, most of which is
used for industrial and other purposes. Anything deliberately put into the
water supply would be greatly diluted. Poisoning water supplies would require
truckloads of biological or chemical agents that are difficult to produce and
relatively easy to detect.

In addition, water treatment facilities routinely filter the water supply and
add chlorine to kill harmful germs.

The U.S. Postal Service delivers roughly 208 billion pieces of mail each year.
Even with increased security measures, it may be impossible to ensure that all
mail is free of biological agents. However, there are simple, commonsense
precautions you can take.

Traits of a suspicious letter or parcel:

no return address

excessive postage

handwritten or poorly typed address, incorrect titles or titles with no name, or misspellings of common words

addressed to someone no longer with your organization or otherwise outdated

unusual weight, lopsided or oddly shaped

marked with restrictive endorsements such as "Confidential"

strange odors, stains, or powders

unexpected or from someone unfamiliar to you

If you handle large quantities of mail from strangers and/or believe you or
your workplace may be targeted for bioterrorism, you may want to take the extra
precaution of wearing plastic gloves and a surgical mask.

A number of different bacteria, viruses, and toxins could be used as weapons of
bioterrorism. Salmonella was used as a food poisoning by a religious cult in
Oregon in the early 1980s to sicken hundreds of people. Biological weapons
programs in the Soviet Union explored the use of smallpox, cholera, and plague.
Among the 28 agents developed by the U.S. biological weapons program of the
1950s and 1960s were the agents that cause tularemia, Q-fever, and Venezuelan
equine encephalitis.

Most disease agents, however, are difficult to process and disseminate
effectively as weapons of mass destruction. See Agents of
Bioterror for a more thorough guide, with information about
diseases and treatments.

Given the attacks upon civilians that took place on September 11, it is
reasonable to feel anxious. However, bioterrorism experts emphasize that the
risks of a wide-scale and successful attack are extremely low. Much greater are
the dangers of letting your fears escalate: Stress weakens your immune system
and can have a spiraling effect as it disrupts your family and work
life.

Should your fear get to the point that it stops you from doing the things you
would normally do in a day, it might be helpful to talk with a counselor. Your
health care provider can make a referral if you do not already have someone in
mind. In the wake of the attack on New York City, we have learned how helpful
it has been to many New Yorkers to speak with a counselor or to go to a mental
health center.